HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 09/30/2016 Permit Number:
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Building Permit Application �; p alu
Planning and Development Services )
Building and Code Regulation Division I v/)")9 } ( nxC
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
':PROPOSED IMPROVEMENT LOCATION:
Address: 501 E Easy St
Legal Description: INDIAN RIVER ESTATES-UNIT-02-6LK 13 LOTS 18 AND 19(MAP 34/11S)(OR 1745-2422)
Property Tax I D#: 3402-603-0208-000-2 Lot No.18
Site Plan Name: Block No. 13
Project Name: Phyllis Johnson
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: /
Water Heater Installation JSz a Jpyi
-CONSTRUCTION INFORMATION:
Additional work toe e Orme under this permit—check a appy:
1_1HVAC Ei Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric EZI Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 8600 Utilities:i Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Phyllis Johnson Name: Joe Gonzalez
Address:501 E Easy St Company: Cookes Plumbing and Septic
City: Ft Pierce State:FL Address: 3100 SE Waaler St
Zip Code: 34982 Fax: City: Stuart State:FL
Phone No.772-408-3892 Zip Code: 34997 Fax: 772-287-1570
E-Mail:sandysmoml981 @att.net Phone No. 772-287-0651
Fill in fee simple Title Holder on next page(if different E-Mail: cayala@callcookes.com
from the Owner listed above) State or County License: CFC056684
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: X Not Applicable MORTGAGE COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signatu of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF , MCO COUNTY OF XM
The forgoing instrument was acknowledged before me The forgoing instr en�t,,was acknowledged before me
this—a day of lv'n/ 20 �by this a day of �uO�L'l� 20 LL, by
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(Name of person acknowledging) (Na a of person acknowledging)
(Signature of Notary7OR
tate of Florida) (Signature of Nota bli State of Florida)
Personally Known Produced Identification Personally Known OR Produced Identification
Type of Identification Prod Type of Identification Produced
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Commission No. 'a D 1144 �A Zt ��a3y�97
MYQE�vHdY15SION#FF234297 Commission No
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MY COMMIISSION#FF234297
Revised 07/15/2014 op �IItMS:July 09,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
. DATE
COMPLETE
INITIALS